FY17 Annual Plan and Budget September 20, 2016 Oakland County’s Public Mental Health System: A Valuable System for Valued People
As Presented By:
Willie Brooks, Jr., Executive Director and CEO Kathleen E. Kovach, Deputy Executive Director and COO Anya Eliassen, Chief Financial Officer Matt Owens, Chief Network Officer
FISCAL YEAR 2017 (FY17) ANNUAL PLAN AND BUDGET PROCESS Oakland County Community Mental Health Authority (OCCMHA) is committed to a three (3) year Strategic Planning cycle, and completed its third Strategic Plan in July 2015. The OCCMHA Board approved the FY16 - FY18 Strategic Plan, which identifies strategic priorities that impact the future of OCCMHA. As always, input from people served, family members, advocates, providers, agency staff, and community organizations is sought throughout the year, and is included in the Strategic Planning and Annual Planning process. The FY17 Annual Plan is the second year of the FY16 – FY18 Strategic Plan. Identified goals are accomplished through the development of specific objectives and timeframes. The FY17 Annual Plan also serves as OCCMHA’s Commission on Accreditation of Rehabilitation Facilities (CARF) Accessibility Plan. While the FY17 Annual Plan focuses on new and emerging initiatives, it also addresses ongoing needs in the areas of housing, employment, transportation, health care, criminal justice, and evidence-based practices. OCCMHA remains committed to those important life outcomes, and works to improve access and quality in those areas for the 25,000 people who are annually served by OCCMHA. In FY14, OCCMHA experienced a $14 million Medicaid reduction due to Michigan Department of Health and Human Services (MDHHS) rebasing, with additional reductions continuing because of ongoing rebasing efforts. Further, the 2014 rollout of the Healthy Michigan Program (HMP) created a $20 million reduction in General Funds (GF) because these funds were shifted to cover the costs of the HMP. The loss of GF resulted in the elimination or reduction of services to individuals who had either Medicaid spenddown costs or reliance on services covered by GF. OCCMHA continues to work with the Provider Network and people served to address the reductions through statewide advocacy for appropriate funding levels, strategic budget planning and program implementation. Efforts remain focused on creating efficiencies, reducing cost variance among network providers, establishing alternative funding models, outcome based contracting, and minimizing, to the fullest extent possible, service impacts for people supported by OCCMHA. Central to this is Person-Centered Planning (PCP), with the responsibility of all involved to access natural and community supports, and to meet identified needs with the ‘right amount, scope, and duration’ of Medicaid funded, ‘medically necessary’ supports, services, and treatment. To better understand the FY17 Annual Plan, a Glossary of Terms is located at the end of this Plan.
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FY17 OCCMHA Annual Plan and Budget
MISSION, VISION AND VALUES Mission OCCMHA’s mission is to “Inspire hope, empower people, and strengthen communities.”
Vision OCCMHA will be a national leader in the delivery of quality integrated physical and mental health supports and services to children and adults with intellectual / developmental disabilities, mental illnesses and substance use disorders. We respond to our community’s needs and empower people to achieve the lives that are important to them.
Core Values These values are expected from all OCCMHA and Provider Network staff in their day-to-day work: ● We promote equality and personal choice leading towards self-directed lives. ● We are guided by the goals, needs, and desires of people we serve. ● We promote and protect the rights of people served as they seek to achieve their personal life outcomes. ● We lead with integrity, accountability, and transparency. ● We strengthen our community by identifying needs and implementing innovative solutions. ● We collaborate in shared purpose with individuals served, families, staff, service providers, and the community.
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PRINCIPLES AND PRACTICES
OCCMHA believes in the following principles and practices when working with individuals served and their families: ● Life planning through Person-Centered / Family-Centered Planning processes; ● A Recovery orientation that provides hope and empowerment; ● Self-Determination which provides greater control over choice of providers, and the use of an individual budget to purchase supports and services identified in the Person-Centered Plan; ● A resilient family perspective that supports keeping families together; ● A Recovery Oriented System of Care (ROSC) that improves the health, wellness, and quality of life for those with or at risk of alcohol and drug concerns; ● Trauma-informed systems that are aware of the impact of trauma in people’s lives; ● Peer delivered supports and services, where people with similar experiences provide hope and guidance toward Self-Determination and Recovery; ● A Culture of Gentleness, where supports and services build upon the strengths of individuals served; ● Cultural sensitivity and competency that honors diversity and assures equal access to services for all who are eligible; ● Community engagement, which involves partnerships and coalitions that mobilize resources and influence systems on behalf of people served; and ● Fiscal responsibility and efficiency, so that people served benefit from the wise use of public funds.
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FY17 OCCMHA Annual Plan and Budget
FY17 ANNUAL PLAN AND BUDGET GOALS FY17 Annual Plan Goals The FY17 Annual Plan activities are derived from the Strategic Priorities identified in the FY16 – FY18 Strategic Plan. The Priorities are listed in alphabetical order, and do not represent a ranking by importance. The intent of the following Priorities, Goals, and Objectives is to positively impact and significantly enhance the lives of people in Oakland County. The Strategic Priorities include: ● ● ● ● ● ● ●
Administration and Operations Advocacy and Empowerment Budget and Finance Children, Youth, and Families Criminal Justice Integrated Healthcare / Health and Wellness Supports and Services
Administration and Operations This priority focuses on business strategies that ensure the effective and efficient management of the Strategic Priorities and other day-to-day activities. Such strategies include operations, staff development, resource investment, policy implementation, data analytics, information technology, communications, and financial management. Sound actions in these areas are the foundation of OCCMHA’s commitment to providing quality services by increasing system wide efficiency, accountability, and innovation. The intent is to maximize services and supports while responding to the current climate of budget reductions. Goals and objectives that support the Administration and Operations priority include: ● Accreditation: Continue with efforts to obtain National Committee for Quality Assurance (NCQA) accreditation, which reflects quality standards and measurements in the healthcare industry. ○ Objective 1: Implement requirements to collect HEDIS measures and begin monitoring performance measures by 9/30/17. ○ Objective 2: Ensure that all NCQA standard sections are ready for mock survey by 9/30/17. ● Data Analytics: Continue the development and use of Dashboards and reports to monitor data points related to people served, authorization and utilization rates, practice models, service outcomes, and costs. Page 4
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○ Objective 1: Utilize current Dashboards to monitor and improve the gap between Authorization and Utilization of services by population served, provider agency, program, and benefit plan by 9/30/17. ○ Objective 2: Review or develop reporting mechanisms to compare the outcomes and costs of at least two (2) additional Evidence-Based Practices by 9/30/17. ○ Objective 3: Develop Dashboards to identify trends related to inpatient admissions and outpatient service authorization / utilization by population served, provider agency, program, & benefit plan by 9/30/17. ● Innovative Technology: Implement technology solutions and information management systems that reduce costs and / or improve services, such as the Electronic Health Record, the Personal Emergency Response System (PERS) and the myStrength application. ○ Objective 1: Implement the new Administrative Electronic Health Record (AEHR), which has more capability, improved functionality, and is more cost effective by 9/30/17. ○ Objective 2: Complete a cost benefit analysis and, if determined, design and implement technology for a Personal Emergency Response System (PERS) that enables people to live more independent lives, while reducing the need for staff and the associated costs by 9/30/17. ● Performance Based Contracting: Develop and implement performance based contracting, which includes outcomes, measures, performance levels, incentives, and performance evaluations. ○ Objective 1: Negotiate and implement new OCCMHA performance based contracts by 9/30/17. ● Provider Network Development and Management: Continue to ensure a quality service delivery system, with a competitive Provider Network that meets the choices and needs of people served, addresses administrative efficiencies, reduces rate variances, and fulfills MDHHS / OCCMHA contractual requirements. ○ Objective 1: Create an OCCMHA Core Provider Agency contract template / framework by 3/31/17. ○ Objective 2: Issue Requests for Proposals (RFPs) for reprocurement of OCCMHA’s Provider Network by 5/31/17. ○ Objective 3: Contract with approved Network Providers by 9/30/17. ○ Objective 4: Evaluate current Provider Network training functions to identify efficiencies, potential consolidation, online training opportunities, and centralization by 9/30/17. ○ Objective 5: Complete an assessment of remaining delegated PIHP functions to determine potential efficiencies, consolidations, or centralization by 9/30/17.
Advocacy and Empowerment This priority focuses on the involvement of people served by OCCMHA, including parents and Page 5
FY17 OCCMHA Annual Plan and Budget
guardians, and the Provider Network in the development, implementation, monitoring, and evaluation of the supports and services they receive. Self-advocacy, individual advocacy, and systems advocacy are supported by OCCMHA as a way of ensuring choice, self-direction, and responsiveness to service and support needs. Goals identified to support the Advocacy and Empowerment priority include:
● Advocacy Efforts: Continue to advocate at local, state, and national levels to ensure that the interests of people served, families, and communities are reflected in the design and implementation of public policies, services, and funding. ○ Objective 1: Continue to provide opportunities for individuals concerned about budget reductions to share advocacy ideas and develop impactful strategies to educate legislators and the community at large about the importance of providing appropriate funding for Michigan’s public mental health system by 9/30/17. (Quarterly advocacy workgroup meetings, public forums, advocacy Google group, social media.) ○ Objective 2: Present public mental health advocates with the necessary tools to express their concerns to legislators about budget reductions that are influenced by rebasing, Healthy Michigan, and General Fund reductions, while also encouraging others to support and join their efforts by 9/30/17. (Legislative contact lists, legislative news, messaging templates.) ○ Objective 3: Collaborate with community stakeholders to monitor and influence all activities surrounding new language and legislation resulting from Boilerplate 298, including leading discussions about the contrasts between specialty public mental health services and private health plans by 9/30/17. ○ Objective 4: Conduct a survey to ensure that people receiving services and their family members have a comprehensive understanding about OCCMHA’s funding sources, as well as the guidelines which outline how these fund sources may be used to support people by 9/30/17. ● Anti-Stigma Education: Continue Anti-Stigma campaigns to improve community understanding and acceptance of people served – intellectual / developmental disabilities, mental illnesses and substance use disorders. ○ Objective 1: Assist in coordinating anti-stigma presentations for OCCMHA’s Provider Network via a joint effort between OCCMHA’s Begin Ending Stigma Today (BEST) and the CNS Anti-Stigma teams by 3/31/17. ○ Objective 2: Work with the Begin Ending Stigma Today (BEST) team to develop FY17 goals by 12/31/17, with a focus on adding stigma related issues for people with intellectual / developmental disabilities as well as people with substance use disorders. ○ Objective 3: Continue to include both BEST and CNS Anti-Stigma team members in quarterly advocacy workgroup meetings by 9/30/17. ● Community Education: Increase the awareness of the role of the public mental health system in Oakland County through media avenues and community collaboration. Page 6
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○ Objective 1: Continue the work of Customer Services and Communications in responding to requests for information and questions from people who cannot attend important OCCMHA meetings by 9/30/17. ○ Objective 2: Cultivate successful community outreach relationships among OCCMHA Core Provider Agencies (CPA), partnering on important advocacy and community outreach efforts by 9/30/17. (Resource Fair, quarterly communication / outreach meetings, network events.) ○ Objective 3: Increase and track OCCMHA's presence on community workgroups and committees, and ensure that vacant committee positions are filled promptly with the assistance of management by 9/30/17. ○ Objective 4: Develop and launch a comprehensive specialty mental health service awareness campaign that includes one-two minute vignettes, billboard and bus advertisements, cable-television spots, and electronic messaging at local movie theatres by 9/30/17. ○ Objective 5: Ensure the community at large is made aware of the OCCMHA Access and SUD (Prior Authorization Central Evaluation) PACE team merger, including new contact information by 9/30/17. (Following the merger, PACE will be referenced as OCCMHA Access only.) ○ Objective 6: Create and launch an extensive media campaign promoting the State’s “Do Your Part: Be the Solution” initiative in response to the opioid and heroin epidemic by 9/30/17. ○ Objective 7: Develop a new OCCMHA logo, which will be unveiled and promoted via an ongoing branding campaign by 9/30/17. ● Person-Centered Planning and Family-Centered Planning: Improve Person-Centered Planning and Family-Centered Planning processes and outcomes, including the use of Independent Facilitation. ○ Objective 1: Train trainers at provider agencies to ensure systemic capacity and fidelity by 3/31/17. ○ Objective 2: Evaluate training results and modify as needed using a combination of audits and feedback from individuals / families served by 9/30/17. ● Civil Rights and Guardianship: Ensure that all people are guaranteed equal treatment under the law regarding enjoyment of life, liberty, property, and protection. Most people can manage their own affairs with informal assistance and guidance from family, friends, and others. When necessary, people should be aware of and have access to preferred alternatives to guardianship. If guardianship is essential, it should be used only to the extent necessary, with a presumption in favor of partial, rather than full guardianship. ○ Objective 1: Develop and implement training about civil rights, supported decision-making, alternatives to guardianship, and guardianship responsibilities by 9/30/17. ● Service and Provider Choices: Increase the awareness of choice and available supports Page 7
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and resources, so that people served are able to make informed decisions about their service options. ○ Objective 1: Finalize a Provider Directory in accordance with NCQA requirements which reflects services, contact information, languages spoken, support groups, provider certification, and referral processes, and post it on OCCMHA’s website, with printed copies available for distribution by 3/31/17. ○ Objective 2: Continue to develop, implement, and evaluate network wide orientation guidelines and protocols for individuals and families new to the OCCMHA system by 9/30/17.
Budget and Finance This priority focuses on the impact of several fiscally related decisions made by the State of Michigan, including the Healthy Michigan Program, Medicaid Rebasing, and changes in General Fund allocations. Because of continued fiscal uncertainty, OCCMHA will continue to explore, develop, and implement the most effective administrative and service delivery system. Goals identified to support the Budget and Finance priority include: ● Budget Planning and Implementation: Continue to implement a budgeting strategy to maintain a balanced budget. Action occurs at all levels – OCCMHA, Core Provider Agencies, Direct Service Providers – to address administrative and service delivery efficiencies, increased use of community resources, adherence to utilization guidelines, reduced community and state hospitalization, and consistency in practice models across the provider network. ○ Objective 1: Continue implementation of funding equity and efficiency to best utilize resources with current year revenue by 9/30/17. ○ Objective 2: Continue to monitor expenses and projections of approved budget reduction plans implemented by provider agencies by 9/30/17. ● Funding Strategy: Develop and implement alternative funding strategies that reduce or eliminate rate variances, and allow for quantitative and flexible models that are outcomes based. ○ Objective 1: Continue work with Contractor in development of new funding model(s) by 9/30/17. ○ Objective 2: Pilot new funding model(s) with all populations by 9/30/17. ○ Objective 3: Prepare for implementation of funding models with remaining providers by 9/30/17. ● Provider Funding: Continue efforts to support appropriate compensation for direct care staff, direct service providers, and Core Provider Agencies, with a focus on value based purchasing. ○ Objective 1: Work with Direct Service Providers on how to best facilitate appropriate staff wages, greater equity and better outcomes, and the appropriate number of providers for different service types by 9/30/17. ○ Objective 2: Continue to redirect available funding to increase direct care staff Page 8
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compensation by 9/30/17. ● Risk Strategy: Continue with risk mitigation strategies related to funding and long term planning. ○ Objective 1: Continue to work with MDHHS to understand the population being served in Oakland County and its unique needs by 9/30/17. ○ Objective 2: Plan for long term funding needs by creating efficiencies that encourage outcomes and independence by 9/30/17. ○ Objective 3: Coordinate with local Partners on community resources for those no longer utilizing OCCMHA services by 9/30/17.
Children, Youth and Families
This priority addresses the support needs of children, youth, and families as they strive to maintain enduring, stable family and community relationships. By aligning with the MDHHS priority to “Improve Outcomes for Children,” OCCMHA plans to work locally to support the belief that “the future of our state rests with our youth.” Goals identified to advance the Children, Youth and Families priority include: ● Evidence Based Practices: Increase the capacity to provide evidence based practices supported by MDHHS for youth and families – Trauma Focused – Cognitive Behavior Therapy (TF-CBT) and Parent Management Training – Oregon (PMT-O). ○ Objective 1: Evaluate effectiveness of current plan to increase capacity and amend, if needed, by 12/31/16. ○ Objective 2: Continue to increase the number of clinicians trained in TF-CBT and PMTO by 9/30/17. ○ Objective 3: Increase the number of youth / families receiving TF-CBT and PMT-O by 9/30/17. ● Family-Centered Philosophy and Practice: Ensure that the Family-Centered philosophy and core practices are consistent across population groups – serious emotional disturbance, intellectual / developmental disabilities, and substance use disorders. ○ Objective 1: As part of the system-wide training and evaluation for the PCP - FCP process, continue to ensure that the Family-Centered philosophy and core practices are embedded into the training of trainers, and the consistent application of the philosophy and practices for all populations served is evaluated using a combination of auditing and input from youth / families served by 9/30/17. ● Infant Mental Health: Incorporate evidence based, Infant Mental Health early intervention practices into OCCMHA’s system of care. ○ Objective 1: Identify staff to complete training in Infant Mental Health to act as subject matter experts within OCCMHA and to guide practices network-wide by 9/30/17. ○ Objective 2: Implement an assessment tool for the 0 - 3 year old population 9/30/17. ● Mental Health Awareness: Participate with the Oakland Intermediate School District (ISD) Page 9
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and Human Services Coordinating Council in the Project AWARE grant to increase access to mental health services for all school aged youth, including assisting with training in Youth Mental Health First Aid. ○ Objective 1: Work with the ISD and MDHHS to complete an analysis of the needs assessment and develop targeted interventions by 12/31/16. Peer Support: Increase the involvement of youth and families in peer related activities, such as Youth Peers, Youth Advisory Groups, Parent System Navigators, and Parent Advisory Councils. ○ Objective 1: Implement the use of Parent Support Partners for people with I/DD within the Provider Network by 9/30/17. School Transition Planning: Continue coordination with the Oakland Intermediate School District to improve Transition Planning and school dropout rates. ○ Objective 1: Continue to develop, implement, and evaluate tracking and outcome metrics by 9/30/17. ○ Objective 2: Coordinate the signing of an interagency commitment between OCCMHA, Oakland Schools, the Department of Health and Human Services, and the Department of Licensing and Regulatory Affairs – Bureau of Services for Blind Persons by 3/31/17. Suicide Prevention: Participate in ‘The Youth Suicide Prevention’ (TYSP) grant activities with the Oakland County Health Division and Oakland Intermediate School District to reduce the instances of suicide attempts and completion for youth aged 10-24. ○ Objective 1: Continue to provide quarterly TYSP grant reporting, as required by MDHHS, by 9/30/17. ○ Objective 2: Coordinate an OCCMHA network event for youth, with the goal of providing all participants with “Okay to Say” resources, as well as develop a youth suicide prevention toolkit by 3/31/17. ○ Objective 3: Develop a written policy to ensure all OCCMHA Access, Customer Services, and Recipient Rights staff receive crisis intervention/suicide prevention training, and recommend plans for a network wide suicide prevention training protocol by 3/31/17. ○ Objective 4: Participate in all suicide prevention community forums and discussions led by the Oakland County Health Division which are funded by the TYSP grant by 9/30/17. Trauma Informed Practice: Participate in the “Breakthrough Series” collaborative, which is a grant funded initiative to pilot a trauma screening and assessment tool for children entering the ‘Department of Human Services’ system. ○ Objective 1: Continue to implement the local and State level “Breakthrough Series” plan with the Oakland County collaborative by 9/30/17. ○ Objective 2: Coordinate and participate in trainings with local child welfare agencies, such as screening and assessment tools, secondary trauma, Trauma Focused - Cognitive Behavioral Therapy (TF-CBT) cohorts and ensure data collection and analysis by 9/30/17. FY17 OCCMHA Annual Plan and Budget
Criminal Justice This priority focuses on improving the wellbeing and recovery of individuals with mental health, substance use, or co-occurring disorders who are involved in the criminal and juvenile justice systems. It complements a strategic initiative identified by the Substance Abuse and Mental Health Services Administration (SAMHSA) strategic plan, which includes diversion practices, links with community-based providers and correctional staff, re-entry programs, training, and policy development. The intent is to provide treatment and recovery services to prevent entry into or deeper involvement with the justice systems. Goals identified to accomplish the Criminal Justice priority include: ● Community Collaboration: Advance collaborative community efforts within the framework of “Stepping Up: A National Initiative to Reduce the Number of People with Mental Illness in Jails.” This initiative asks that organizations come together to develop an action plan that can be used to achieve a measurable impact in local criminal justice systems. ○ Objective 1: Collaborate with key partners to develop and launch a learning seminar/conference for the community about key areas where mental health and the law intersect, i.e., Kevin’s Law, petition/certification process, court hearings, guardianship, etc. by 9/30/17. ○ Objective 2: Continue to use the “Stepping Up” Toolkit to compare current activities to recommended action plan steps by 3/31/17. ● Criminal Justice Diversion: Identify funding and increase the number of successful diversions from contact with, or penetration into the Criminal Justice system for persons with an identified mental health need. ○ Objective 1: Continue to pursue funding opportunities to expand Crisis Intervention Team (CIT) trainings, and other trainings, offered to law enforcement personnel to improve responses to people in mental health crises. Grant application to be submitted by 1/1/17. ○ Objective 2: Continue to work with Michigan State University (MSU) for outcomes evaluation of grant-funded diversion initiatives by 9/30/17. ○ Objective 3: Implement the REACH position (Rapid Engagement and Access to Community Health) to support those who are exiting Oakland County Jail with an identified mental health need. Development of this role comes in response to the work with the National Council in 2016. Role embedded and outcomes defined by 3/31/17 ● Court Programs: Opportunities exist for OCCMHA to partner with both District and Circuit Courts to pursue establishing Mental Health Courts and to maintain the Adult Treatment Court. ○ Objective 1: Collaborate with local District Courts in pursuing a Supreme Court Administrative Office (SCAO) grant since OCCMHA is a required partner in their application to plan for a Mental Health Court by 3/31/17. ○ Objective 2: Participate in the grant renewal for the Adult Treatment Court (ATC) by 12/31/16. Page 11
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○ Objective 3: Increase cross-system awareness between the local judicial system and the public mental health system, by participating in at least two (2) learning sessions by 9/30/17. ● Juvenile Justice: Advance collaboratives and initiatives to divert youth in Oakland County who have an identified mental health need, from the Juvenile Justice (JJ) system and into treatment/supports. ○ Objective 1: Fully implement the OCCMHA Juvenile Justice Liaison position at the Probate Court/Juvenile Justice Division, with outcomes defined and collection of data points formalized by 9/30/17. ○ Objective 2: Establish opportunities for ongoing cross-system training / learning between the OCCMHA network and the Juvenile Justice Court Division by 3/31/17. ○ Objective 3: Participate as a member of the Oakland County Mental Health/Juvenile Justice Collaborative, with the goal of improving outcomes for cross-system youth (DHHS, JJ, OCCMHA) by 9/30/17. ○ Objective 4: Explore improved models of practice in psychiatric service delivery within Children’s Village, including coordination of care and transition planning back to the community by 3/31/17.
Integrated Healthcare / Health and Wellness This priority reflects OCCMHA’s response to changes in healthcare reform, healthcare integration, and health and wellness expectations for people served. Integration across physical health and mental health systems addresses the needs of the ‘whole’ person, and increases access to quality prevention, treatment, and wellness services. It supports the ‘triple aim’ of healthcare reform – better coordination of care and service satisfaction, improved health outcomes, and lower costs. The need for integrated healthcare and improved health and wellness is a strategic priority of the MDHHS and SAMHSA. Goals identified to respond to the changing healthcare environment include: ● Care Coordination: Collaborate with Core Provider Agencies, Medicaid Health Plans, and Oakland Integrated Health Network (OIHN) to identify mutually served, high risk individuals, and implement care coordination plans to improve health and reduce costs. ○ Objective 1: Continue to develop care coordination practices to be replicated system-wide that meet all care coordination and complex case management requirements by 9/30/17. ● Emergency Department and Hospital Visits: Lead a regional collaborative with tri-county PIHPs and hospital systems to develop next steps to reduce Emergency Room boarding and Emergency Department utilization. ○ Objective 1: Coordinate meaningful data to effect positive changes in target areas that impact Emergency Room boarding and hospital access challenges by 9/30/17. Page 12
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○ Objective 2: Increase use of in-patient diversions ( ACT, Crisis Residential Unit, mobile crisis team) through data analysis and funding model changes by 9/30/17. ● Integrated Healthcare Training: Continue to implement and modify, as needed, the Integrated Healthcare Training Plan, which builds the skills and capacity of the Provider Network to deliver quality, integrated healthcare. ○ Objective 1: Create a recording of each training module to be available to all Network Providers by 3/31/17. ○ Objective 2: Use pre and post testing data to evaluate training effectiveness and, if needed, modify training curriculum by 9/30/17. ● Oakland Integrated Healthcare Network (OIHN): Continue to evaluate OCCMHA’s contractual relationship with OIHN, a Federally Qualified Healthcare Center (FQHC) to ensure the delivery of quality integrated healthcare for people mutually served. ○ Objective 1: Monitor OIHN’s contract requirements, including financial status, patient data, and patient outcomes, with an expected 5% increase in patient encounters by 9/30/17. ● Population Health Management: Continue Population Health Management data analytics to identify health risk trends and high costs, and assist in decision making about needed supports, clinical and system practice changes, training, and funding. ○ Objective 1: Continue utilization of population health management data to implement an outcome improvement plan for each population served by 9/30/17. ○ Objective 2: Continue the utilization of population health management data sets to identify health risks / trends by service area, and develop a plan to provide support and assistance in identified areas by 9/30/17.
Services and Supports This priority promotes the continuous quality improvement of supports, services, and clinical practices offered by OCCMHA and the Provider Network. Some have been identified by people served and families as most important for improvements in their lives. Generally, there are four major dimensions that support quality of life – health, home, purpose, and community. Goals that focus on the Services and Supports priority include: ● Crisis Services: Improve crisis stabilization and treatment services to address emergency department use, hospitalization, and incarceration. ○ Objective 1: Continue to develop a crisis services Dashboard to track data and measure success in preventing crises by 3/31/17. ○ Objective 2: Evaluate the possible system gaps in mobile crisis response, particularly for youth and families, and provide a proposal for meeting the identified need by 3/31/17.
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● Culturally Competent Services: Address disparities experienced by racial, ethnic, and underserved groups (deaf community, veterans, older adults, transition-aged youth, lesbian, gay, bisexual, and transgender (LGBT) individuals) by improving culturally competent prevention, treatment, and supportive services. ○ Objective 1: Utilize the SAMHSA guidelines to develop a work plan in accordance with the OCCMHA health disparities impact statement that addresses how OCCMHA will use data to identify underserved groups and implement strategies to improve access, service use, data collection, and outcomes by 9/30/17. ● Employment: Increase the number of individuals served by the OCCMHA system who are working in integrated, competitive employment and earning a prevailing wage. ○ Objective 1: Maintain good fidelity for Individual Placement Supports and Supported Employment programs by 9/30/17. ○ Objective 2: Continue to increase the percentage of individuals who identify employment as a need in the Life Domain Assessment and have an employment goal in their Individual Plan of Service (IPOS) by 9/30/17. ○ Objective 3: Pilot a customized employment program, in partnership with Michigan Rehabilitation Services (MRS), that increases the integrated, competitive employment outcomes for individuals with intellectual / developmental disabilities by 9/30/17. ○ Objective 4: Increase the number of Transitional Employment positions available at Clubhouses by 9/30/17. ○ Objective 5: Continue to address the MDHHS requirements related to the Home and Community Based Services (HCBS) Transition Plan for day programs, workshops, and pre-vocational centers by 9/30/17. ● Housing: While respecting individuals’ right to make choices that reflect their unique preferences, OCCMHA will strive to increase the accessibility of safe, affordable, and least-restrictive housing. ○ Objective 1: Continue to increase the number of affordable and subsidized housing units dispersed throughout Oakland County by 10 per year by 9/30/17. ○ Objective 2: Continue to address chronic homelessness and improve integration of services by participation in Projects to Assist in Transition from Homelessness (PATH), Shelter Plus Care, and the Oakland County Homeless Alliance by 9/30/17. ○ Objective 3: Continue to address and adjust housing requirements based on MDHHS criteria related to the Home and Community Based Services (HCBS) Transition Plan for residential group homes and adult foster care homes by 9/30/17. ● Substance Use Prevention and Treatment: Continue implementation of the OCCMHA SUD Three Year Strategic Plan, which address substance use disorder prevention, treatment and recovery, including opioid use prevention, Medication Assisted Treatment (MAT), trauma-informed culture and therapies, and healthcare coordination. ○ Objective 1: Continue the Opioid Use Prevention initiative, which includes law enforcement training for opiate overdose prevention and naloxone / narcan medication, training families, distributing medication to the community, and expansion of the “Do Page 14
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Your Part” prescription drug campaign by 9/30/17. ○ Objective 2: Transform the SUD Provider Network to a trauma informed system through training, protocol development, and provider monitoring by 9/30/17. ○ Objective 3: Issue a Request for Proposal (RFP) to address outpatient and Medication Assisted Treatment (MAT) needs by 3/31/17. ○ Objective 4: Continue the transformation of Medication Assisted Treatment per MDHHS requirements, including contracts, medication protocols, assessments and inclusion of integrated care by 9/30/17. ● Transportation: Increase transportation options through a coordination of transportation systems that leverages resources to increase rides, reduce costs, streamline access and increase customer satisfaction. ○ Objective 1: Continue to participate in the Oakland County Homeless Healthcare Collaboration Transportation Taskforce to develop a plan that addresses transportation as an identified barrier for people who are homeless and those living with low incomes to access community services, such as healthcare, by 9/30/17. ○ Objective 2: Participate with Taskforce efforts to utilize SMART Bus funding opportunities to expand transportation options for people and families served by Taskforce participants, OCCMHA, and the Provider Network by 9/30/17.
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FY17 OCCMHA Annual Plan and Budget
FY17 PROGRAM AND BUDGET PLAN Fiscal Year October 1, 2016 through September 30, 2017 Budget Narrative
Overview Fiscal Year 2016-17 (FY17) will reflect outcomes of the prior year’s efforts from OCCMHA and its providers to identify efficiencies, as well as adjust expenses to match revenue by fund source. While OCCMHA will experience the last two iterations of Medicaid rebasing in October and April, FY16 savings and the continued realization of efficiencies will offset these reductions. OCCMHA expects the Medicaid reduction in FY17 to be roughly $7 million. In addition, new methodology has been created for General Fund (GF) distribution across the State. This new methodology will result in OCCMHA receiving a reduction; MDHHS has not determined the final amounts or timeframe for this implementation. Because of this change, the FY17 GF revenue is budgeted at the FY16 amount. Healthy Michigan Program (HMP) revenue is expected to remain consistent at FY16 amounts. In FY16, OCCMHA distributed a 50 cent increase to direct service staff and has committed to continuing this in FY17. OCCMHA plans to ensure an appropriate wage to direct care staff as funding allows. This amount was $2.5 million in FY16 and annualized in FY17 at $5 million, for a total of $7.5 million directed to direct service staff wages. In FY14, GF revenue was reduced by roughly 55% for the 3rd and 4th quarters of the year. For FY15, the appropriation was a 66% reduction from historical amounts. The result of FY15 and FY16 reductions is residual community GF revenue of approximately $12 million, down from the previous $30 million. MDHHS ended OCCMHA’s full management of the State Facilities on September 30, 2015, which reduced the associated revenue and expense. The local obligation for State Facilities will remain and is expected to be roughly $2 million. On April 1, 2014, Medicaid Expansion began via the HMP, and the Adult Benefit Waiver (ABW) ended. The State introduced a geographic factor in FY16 that significantly increased revenue. OCCMHA has been able to put a small amount of savings into a Healthy Michigan Internal Service Fund (ISF), and plans to continue to do so with any excess revenue over expenses. There is a significant need for OCCMHA to build a reserve for HMP, as OCCMHA is not able to use Medicaid ISF for overages and has a 7.5% risk corridor for this fund source. OCCMHA, through its ongoing Budget and Planning processes, is committed to analyzing resource allocation methods and deploying funding to best fulfill its mission, vision, and values for the people Page 16
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served. At the same time that OCCMHA is advocating for sufficient funding for the public mental health system, OCCMHA is also working with the Provider Network in a thoughtful, inclusive, and collaborative process to resolve current budget issues, as well as those on the horizon. OCCMHA’s goal remains to ultimately operate within reduced funding constraints. Further detail can be found in the attached Budget and Charts.
Fund Source Background Medicaid Until FY14, OCCMHA had seen considerable growth in its revenues. This growth was realized despite GF reductions and Medicaid rate rebasing that eroded OCCMHA’s Medicaid rates, and, therefore, its revenue base by 4% - 5% per year for FY10, FY11, and FY12, and by 6% in FY14. These rate reductions represented decreases to the revenue base of approximately $10 million each year for FY10 through FY12, and then $14 million for FY14. In FY14, OCCMHA received a $14 million reduction as a result of the Medicaid rate rebasing. While OCCMHA was not negatively rebased in FY15, FY16 brought a new round of rebasing. The first round was a 1.2% rate reduction that took effect on April 1, 2016. The two remaining reductions at 1.2% each will take place in FY17. The net growth in Medicaid revenue through FY12 was attributable to increases in the counts of people eligible for Medicaid in Oakland County. The basic formula for Medicaid revenue is a financial rate per person that is multiplied by the number of people in Oakland County who are eligible for Medicaid. In FY12 and again in FY13, Oakland’s eligible trend no longer increased, and began to decrease toward the end of FY13 for the Temporary Aid to Needy Families (TANF) population. The eligible count trend changed in FY14 and flattened considerably. The eligibility trend in FY15 continued to decrease and remained relatively flat in FY16. The TANF population continues to decrease despite the services need remaining the same for this population. In FY14, OCCMHA implemented a portion of the $14 million Medicaid reduction, used all of the FY13 Medicaid savings and used roughly $2 million of Medicaid ISF to cover expenses. For FY15, the loss of savings created an $11 million hole in the budget, plus the remaining hole related to the FY14 Medicaid reduction. The FY15 budget included reductions to cover all but $5 million of that combined total shortfall. The remaining shortfall reductions were implemented FY16. Because of the FY15 implementation of stricter criteria for entering the OCCMHA system due to budget constraints, it is expected that the number of people entering the system will be reduced, in addition to some being referred to community resources for ongoing services. This change in eligibility criteria is due to the decline in GF and the inability of OCCMHA to continue to support individuals with Medicaid spenddown who have mild to moderate mental health needs. Page 17
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In FY16 OCCMHA had the first of three rate reductions that will be fully implemented by April 2017. In addition to this reduction, adjustments to the ‘capitation to eligibility ratio’ resulted in an offsetting increase to Medicaid revenue. This additional Medicaid revenue, as well as other implemented efficiencies, allowed for OCCMHA to have Medicaid carry-forward in FY17.
Healthy Michigan Program (HMP) The HMP began on April 1, 2014, to cover uninsured adults whose annual income is up to 138% of the Federal poverty level. At the same time, the ABW program ended – an annual loss of $3.5 million. With the start of this program, all persons served by OCCMHA that were considered to be mild to moderate in need were transferred to the MHP, with some exceptions. In FY15, OCCMHA saw a considerable increase in the number of people enrolled in the HMP. This trend continued throughout most of the year and only flattened out towards the end of the fiscal year. FY16 enrollment remained relatively flat and is expected to do the same in FY17. While OCCMHA experienced a loss in HMP revenue early on, the geographic factor has leveled this out and allowed for a small savings to begin to build a HMP ISF
General Fund (GF) At the time of this Plan, OCCMHA is projecting roughly $12.7 million in GF for FY17. There was a MDHHS statewide workgroup that worked to redistribute GF across the 46 Community Mental Health Specialty Programs (CMHSP). New logic for distribution was developed, but MDHHS has not yet identified the final amount or implementation plan. OCCMHA’s full management of the State Facilities revenue ended on September 30, 2015. OCCMHA lost the GF portion of this funding and the associated expense. OCCMHA is no longer responsible for managing this within the GF authorization. OCCMHA is still responsible for the local share of the State Facility use, which is expected to be around $2.2 million. Categorical revenue in FY17 will be reduced due to the elimination of the funding pass through for the Arab-American Chaldean population.
Substance Use Disorder (SUD) With the merger between OCCMHA and the SUD Coordinating Agency (OSAS) in FY15, OCCMHA assumed responsibility for the management of the Medicaid funding, the Healthy Michigan Funding, the Substance Abuse Prevention and Treatment (SAPT) Block Grant, the PA2 funding (Liquor Tax), the State Disability Assistance, and the SUD MiChild program. The SUD funding is projected to have a surplus in both FY16 and FY17 due to the PA2 funding received each year. OCCMHA continues to work to responsibly use all revenue to meet its mission, vision, and values.
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Local Local revenue is revenue from Oakland County to meet our 10% local match obligations, local share of State Facility expenses, and other community benefits. The amount has remained constant at $9,620,616 since OCCMHA became an Authority.
FY17 Overview FY17 will continue to focus on fund source management and adjusting expenses to match revenue by fund source. OCCMHA has many different fund sources. All of those fund sources, with the exception of revenue from the local area, have very specific rules and regulations around who and what they can be spent on. With the addition of the HMP and the associated reduction in GF, OCCMHA lost a significant amount of flexibility in revenue. While OCCMHA has always managed by fund source, historically the Contract Service Providers have not been managed by fund source as there was enough flexibility in GF revenue to bear that risk. Given the loss of flexibility in the HMP and reductions to GF and Medicaid, OCCMHA has to manage fund sources much more stringently. In addition to managing fund sources more closely, OCCMHA and its Provider Network began implementing several efficiency and programmatic changes in FY16. OCCMHA will continue developing and implementing new funding models that provide equity and flexibility across Providers.
Revenues For FY17, total revenues are projected at roughly $321 million, which is a net decrease of $8 million from FY16 Budget Amendment #3. The reduction is primarily due to the continued rebasing OCCMHA will be incurring in FY17. OCCMHA does plan to have roughly $8.6 million in Medicaid savings to carry forward into FY17 from FY16. This money will help offset the Medicaid rate reduction while OCCMHA and its Provider Network continue to work on efficiencies and outcome based services. Medicaid Specialty Revenues are decreased by $9.4 million, which is primarily due to the continued rate rebasing planned for FY17. Autism revenue is also expect to be reduced by roughly $700,000 with the change from a fully cost settled fund source to a fee-for-service fund source. The difference between Autism revenue and expense will be funded by Medicaid Speciality revenue. Healthy Michigan revenues are estimated at $31.8 million. MDHHS added a geographic factor to the OCCMHA HMP rates in FY16, which allowed for OCCMHA to fully cover HMP expenses. This is expected to continue in FY17. Community GF is expected to remain flat at the current OCCMHA base of $12.7 million. This assumes that there will not be a MDHHS GF redistribution. If that were to occur, the budget will be updated. There is a slight reduction to categorical funding due to MDHHS contracting directly for some of the multicultural dollars. Page 19
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The SUD Other revenue is projected to remain consistent in FY17.
Expenses The FY17 expenses are budgeted to incorporate the $5 million in direct service staff wages OCCMHA implemented in FY16. In addition to this, new Department of Labor overtime rule changes will also have an impact on the FY17 provider expenses. There will be some offset savings from efficiencies and the implementation of alternative funding models. However, in general, there will be an overall increase in cost to the Network. OCCMHA, Core Provider Agencies, Direct Service Providers, and people served continue to work on efficient and effective ways of delivering services. This includes looking for administrative savings, service delivery efficiencies, rate restructuring with Providers, and increased use of community resources, including the use of the OIHN and the Medicaid Health Plans (MHP) to provide services as part of the recovery pathway, adherence to utilization guidelines, rate setting, and consistency in practice models across the OCCMHA service network.
Use of Reserves and Savings OCCMHA is projecting roughly $8.6 million in Medicaid savings to be brought into FY17 from FY16. Unfortunately, due to the rate rebasing that will continue in FY17, this money should be understood as one time money and not a long term revenue for the network. OCCMHA’s currently projected expenses exceed FY17 revenue. Therefore, OCCMHA will use some of the one time, Medicaid savings. OCCMHA will continue to work on efficiencies that will bring expenses in line with current year revenue. Please see the Fund Source Summary chart for further information.
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Revenue
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Expenses
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Reserve Funds
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Use of Reserves FY14 - FY16
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FY17 PROVIDER NETWORK OCCMHA continues to contract with a Core Provider Agency Network that is responsible for delivering a comprehensive set of services and supports through net cost, performance based contracts. As of 10/1/14, OCCMHA assumed direct contracting for Substance Use Disorder (SUD) prevention and treatment providers, who are reimbursed via fee for service contracts. Two (2) Core Provider Agencies provide supports and services to Children and Youth with Serious Emotional Disturbances and their families: Easter Seals Michigan and Oakland Family Services. Three (3) Core Provider Agencies support Adults with Mental Illness: Community Network Services (CNS), Easter Seals Michigan, and Training and Treatment Innovations. Two (2) Core Provider Agencies are available to Children and Adults with Developmental Disabilities: Community Living Services – Oakland County and Macomb Oakland Regional Center. Common Ground provides hospital admission emergency screening, crisis residential and crisis mobile team services, and specialty services to all populations throughout Oakland County. SUD prevention needs are met through nine (9) prevention providers, and SUD treatment is made available through seventeen (17) providers. A new service, social detox, will be located at the Resource and Crisis Center, and will be administered by Common Ground. Other specialized providers who support the entire Network include: Arab American Chaldean Council; Community Housing Network; Community Hospitals; Michigan Consumer Evaluation Team; Neighborhood Service Organization; Peer Choices; State Facilities; and Oakland Integrated Health Network. OCCMHA’s entire Provider Network has more than 625 contract providers, including Core Provider Agencies, Specialty Providers, and Direct Service Providers. Within this Provider Network, approximately 660 staff provides Supports Coordination / Case Management or In-Home Supports or Assertive Community Treatment (ACT) to people served. Their role is to ensure the development, implementation, and monitoring of Individual Plans of Service, so that people served achieve their life dreams and goals. Nearly 100 therapists provide a variety of services, such as counseling, family therapy, occupational therapy, speech therapy, and numerous Evidence-Based Practices.
OCCMHA is committed to being a relevant and effective resource to Oakland County’s diverse community. This includes identifying and strengthening partnerships that promote cultural competency and awareness about ethnic, racial, faith, and other important factors that impact Page 27
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people’s lives. Organizations that OCCMHA has successfully cultivated meaningful relationships with include Deaf Community Advocacy Network, El Centro La Familia, faith-based groups, Oakland County Health Division, Oakland County Housing Alliance, Oakland Schools, Oakland University, the Oakland County Sheriff’s Office, and the Veteran’s and National Guard Associations, to name a few.
FY16 CORE PROVIDER AGENCY CONTRACTS The FY17 Core Provider Agency contracts reflect OCCMHA’s contract obligations to the Michigan Department of Health and Human Services. The contract format was revised in FY08 to be consistent with the Uniform Contract, which was developed by a statewide Michigan Association of Community Mental Health Boards (MACMHB) committee. Further revisions were made in FY13 to clarify the delegated administrative requirements of the Core Provider Agencies, and for consistency with the OCCMHA Prepaid Inpatient Health Plan (PIHP) Application for Participation (AFP). These modifications include a clearer explanation of the managed care functions that are delegated by OCCMHA to the Core Provider Agencies, with a separate section for service obligations. Additional changes related to delegated functions were implemented in FY15, FY16, and will continue in FY17 as OCCMHA reviews all delegated functions to determine the most effective way to manage service and Provider Network efficiencies. In addition, OCCMHA will continue developing and rolling out new funding model(s) in FY17, which will affect the contract Attachment A structure and methodology. Performance based contracts will continue to be developed in FY17 to include outcomes, measures, performance levels, incentives, and performance evaluations. The FY17 contract attachments include the following: ● Attachment A – Budget: The structure of this attachment will be revised, as needed, to meet costing and other administrative reporting needs. ● Attachment B – Scope of Work: This attachment provides a list of services, descriptions, and procedure codes for the Medicaid services that OCCMHA’s Provider Network is responsible to provide. ● Attachment C – Delegated Functions: This attachment establishes the managed care administrative functions delegated by OCCMHA to the Core Provider Agencies. ● Attachment D – Provider Reporting Requirements: This attachment contains a listing of all items required for submission to OCCMHA, as well as due dates.
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FY17 Grants The following grants are approved by the Michigan Department of Health and Human Services: ● Renewal of Region 8 Coordination of Parent Management Training – Oregon Model. This grant is for $80,000 and covers .25 FTE at OCCMHA. ● Renewal of Adult Mental Health Block Grant – Integrated Healthcare. This grant is for $350,000. ● Renewal of the PATH housing funds. This grant is for $189,898. ● Renewal of the Jail Diversion grant. This grant is for $400,000. ● Renewal of the Shelter Plus housing funds. This grant is for $531,970. ● Renewal of the Youth Suicide Prevention grant. This grant is for $200,000 and covers .25 FTE at OCCMHA. It is in collaboration with the Oakland Intermediate School District and the Human Services Coordinating Council. ● Renewal of Drop In grants. These grants are $5,000 each for a total of $15,000. ● Renewal of Vietnam Veterans grant (previously categorical funding). This grant is for $15,104. ● Renewal of Hispanic Behavioral Health Services grant (previously categorical). This grant is $88,196. ● Renewal of AWARE grant. The grant for $52,485 and covers .5 FTE at OCCMHA. It is in collaboration with the Oakland County Health Division and the Oakland County Intermediate School District.
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FY17 Glossary of Terms Adult Benefit Waiver (ABW): The ABW Program ended on April 1, 2014, with the beginning of the Healthy Michigan Program. Carry Forward: OCCMHA is permitted under the Mental Health Code and its General Fund (GF) contract with the State to carry forward up to 5% of the unspent GF from one year into the next fiscal year. The funds must be used in the subsequent year. The GF revenue is deferred to the next fiscal year to be spent by OCCMHA. For budget purposes, OCCMHA recognizes 1/12th of the total deferred per month. Categorical Revenue: Categorical funding is established by MDHHS for targeted areas of spending. The funds can only be used for MDHHS specific purposes; unspent funds are lapsed back to MDHHS. At this time, it includes services for multicultural programs. The amounts are established by the State annually. This is received monthly, along with the GF. Empowerment of People Served: The participation of people served by OCCMHA in organizational planning, decision-making, program development and evaluation, access to resources, and opportunities to develop and run services, all of which maintain and enhance personal dignity and integrity. Culture of Gentleness: Establishing respectful, nurturing, and safe environments is central to a “Culture of Gentleness.” The goal is to validate each individual’s humanity, while ensuring an environment where the person is supported to build relationships and improve their quality of life. Calmness, personal care, tenderness, and compassion to those served are shown by the actions, words, eyes, and tone of those who support them. Dashboard: A dashboard is a visual display on a computer screen of the most important information needed to achieve the objectives of an organization, such as financial costs and graphs related to services delivered and Quality of Life outcomes and measures. It aids staff and organizations to evaluate and improve service delivery and the administrative processes that support the service delivery system. Disabled, Aged and Blind (DAB): This revenue is based on the number of people identified each month by the State to be in Oakland County that meet specific eligibility criteria of income, age and disability, etc. These are primarily persons who qualified for Supplemental Security Income (SSI) or Social Security – Disabled (SSD), as well as Medicaid persons over the age of 65 years. OCCMHA is paid each month on a per enrolled / eligible persons amount computed through a rate, age / gender / geographic region matrix, which is established by the state actuary each year. The rate matrix is approved by the Centers for Medicare and Medicaid Services (CMS) as part of the waiver approval. Federally Qualified Health Center (FQHC): A federally qualified health center (FQHC) is a type of provider defined by the Medicare and Medicaid statutes. FQHCs include all organizations receiving Page 30
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grants under Section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. Benefits include: Enhanced Medicare and Medicaid reimbursement; Medical malpractice coverage through the Federal Tort Claims Act; Eligibility to purchase prescription and nonprescription medications for outpatients at reduced cost through the 340B Drug Pricing Program; Access to National Health Service Corps; Access to the Vaccine for Children program; and Eligibility for various other federal grants and programs. General Fund Revenue (GF): These funds are part of the State's GF budget appropriation. Amounts are distributed to each Community Mental Health Specialty Program, based on a formula and prior history, along with any adjustments MDHHS determines to be appropriate for revenue reallocation. Historically, OCCMHA is among the highest in GF and formula average. Payments are made monthly to OCCMHA and can be adjusted by various factors. One factor influencing the amount paid by the State would be State lease payments agreements (for group) homes, which are transferred to OCCMHA after the original lease between the State and the landowner is terminated. Habilitation – C-Waiver (HAB) Revenue: OCCMHA is reimbursed for the number of people served who are enrolled in the C-Waiver program. The individual must meet specific criteria for need, i.e., meet criteria to be in a State Facility or Intermediate Care Facility for persons with a developmental disability, which has been established by the State in the C-Waiver program and is approved through the Centers for Medicare and Medicaid Services (CMS). OCCMHA is paid an amount for each enrollee. OCCMHA currently has 862 HAB waiver certificates. Individuals served must receive a monthly HAB Waiver service and be Medicaid eligible for OCCMHA to receive payment for that individual in that month. HEDIS: The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. HEDIS consists of 81 measures across 5 domains of care: 1) Effectiveness of Care; 2) Access/Availability of Care; 3) Experience of Care; 4) Utilization and Relative Resource Use; and 5) Health Plan Descriptive Information. HEDISA makes it possible to compare the performance of health plans on an “apples-to-apples” basis. Income from Investments: OCCMHA earns interest income from all of its operating cash accounts, as well as its investment accounts. The amounts received and accrued are reported for all general operating accounts and are invested based on the Board approved investment policy. Individual Plan of Service (IPOS): An individualized plan that is developed as a result of a Person-Centered / Family-Centered Planning meeting. Goals are identified and strategies are developed to help people achieve their dreams. Integrated Health Care: Integrated care occurs when mental health specialty providers and general medical care provider’s work together to address both the physical and mental health needs of the person served. Integration improves services in relation to access, quality, user satisfaction, and efficiency. Continuity of care occurs through the use of shared records across systems, joint planning on behalf of the person served, and provider consistency. Page 31
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Internal Service Fund: Savings of unspent Medicaid revenue to be used at a future date. The unspent funds are restricted for use on Medicaid and Healthy Michigan service as a risk reserve. Medicaid Children’s Waiver Revenue: Fee for service revenue for children with Developmental Disabilities (DD) who are enrolled in the DD Children’s Waiver program. The children must be approved by the State for entry into the program by meeting specific criteria, which the State has established. Children's Waiver services are currently provided by Macomb-Oakland Regional Center (MORC). MORC bills the State for services rendered. OCCMHA is reimbursed a fee-for-service rate that is established by the State. OCCMHA prepays MORC for the costs of providing these services under its provider contract and costs settles with MORC at fiscal year-end. Medicaid Savings / Carry Forward: The PIHP may retain unexpended Medicaid Capitation funds up to 7.5% of the Medicaid/Healthy Michigan Plan pre-payment authorization. All Medicaid savings funds reported at fiscal year-end must be expended within one fiscal year following the fiscal year earned for Medicaid services to Medicaid covered consumers. All Healthy Michigan Plan savings funds reported at fiscal year-end must be expended within one fiscal year following the fiscal year earned for Healthy Michigan Plan services to Healthy Michigan Plan covered consumers. Medicaid SED Children’s Waiver Revenue: Fee for service revenue for children with Serious Emotional Disturbance (SED) who are enrolled into the SED Children’s Waiver program. The children are referred by the MDHHS ‘Department of Human Services’ (DHS) from out-of-home placements and must be approved by the State for entry into the program by meeting specific, severity criteria that the State has established. Medical Necessity: For individuals served, the determination of a medically necessary support, service or treatment must be: ● Based on information provided by the beneficiary, beneficiary’s family, and/or other individuals (e.g., friends, personal assistants/aides) who know the beneficiary; ● Based on clinical information from the beneficiary’s primary care physician or health care professionals with relevant qualifications who have evaluated the beneficiary; ● For beneficiaries with mental illness or developmental disabilities, based on person-centered planning, and for beneficiaries with substance use disorders, individualized treatment planning; ● Made by appropriately trained mental health, developmental disabilities, or substance abuse professionals with sufficient clinical experience; ● Made within federal and state standards for timeliness; ● Sufficient in amount, scope, and duration of the service(s) to reasonably achieve its/their purpose; and ● Documented in the Individual Plan of Service (IPOS). MlChild: The Children’s Health Insurance Program (CHIP) Program is a federal program administered by the State for children who do not qualify for Medicaid and are between 150% and 200% of the federal poverty level. They are enrolled in the program by the State and are residents of Page 32
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Oakland County. OCCMHA receives a mental health benefit, capitated amount per enrollee per month for the Federal share. Miscellaneous Revenue: Revenue received which does not fall within any of the other revenue categories. The amounts in the account are generally small, are generally not part of general operations, and are recorded as incurred. myStrength: myStrength (The health club for your mind™ ) offers web and mobile self-help resources, empowering people to be active participants in their journey to becoming – and staying – mentally and physically healthy. OBRA Reimbursement: Fee for service revenue billed to the State for Pre-Admission Screening and Annual Resident Review (PASARR) services, which are nursing home assessments for people with mental illness or developmental disabilities. OCCMHA bills the State for the cost of the assessment plus administration. OCCMHA receives the payments from the State and, through a provider contract with Neighborhood Services Organization (NSO), reimburses them a fee for the services provided. Performance Based / Pay for Performance Contracting: Performance Based Contracting is a results-oriented contracting method that focuses on the outputs, quality, or outcomes that may tie at least a portion of a contractor’s payment, contract extensions, or contract renewals to the achievement of specific, measurable performance standards and requirements. These contracts may include both monetary and non-monetary incentives and disincentives. Person Centered / Family Centered Planning (PCP-FCP): An ongoing process in which an individual's / family’s dreams and goals are discussed and strategies are identified for reaching those goals. This process is rooted in a profound respect for the individual / family, and an expectation that the person served is included in his / her community and has a meaningful quality of life experience. Recovery: A journey of healing and transformation enabling a person with a mental illness to live a meaningful life in a community of his / her choice, while striving to achieve his / her full potential. The ten (10) components of recovery are: 1. Self-Direction: People served lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals. 2. Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies, as well as his / her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result, as well as an overall paradigm for achieving wellness and optimal mental health. 3. Empowerment: People served have the authority to choose from a range of options and to Page 33
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participate in all decisions – including the allocation of resources – that affect their lives, and are educated and supported in so doing. They have the ability to join with others served to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life. 4. Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for individuals served to have access to these supports. 5. Non-Linear: Recovery is not a step-by-step process, but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the individual to move on to fully engage in the work of recovery. 6. Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, people leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, and employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships. 7. Peer Support: Mutual support – including the sharing of experiential knowledge and skills and social learning – plays an invaluable role in recovery. People receiving services encourage and engage others served in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community. 8. Respect: Community, systems, and societal acceptance and appreciation of people receiving services – including protecting their rights and eliminating discrimination and stigma – are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of individuals in all aspects of their lives. 9. Responsibility: People have a personal responsibility for their own self-care and journeys of recovery. Taking steps toward their goals may require great courage. Individuals must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness. 10. Hope: Recovery provides the essential and motivating message of a better future; people can Page 34
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and do overcome the barriers and obstacles that confront them. Hope is internalized, but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Mental health recovery not only benefits individuals by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. Recovery Oriented System of Care (ROSC): A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug concerns. Resiliency: An inner capacity that when nurtured, facilitated, and supported by others, empowers individuals and families to successfully meet life’s challenges with a sense of self-determination, mastery, and hope. Self-Determination: The five (5) principles of Self-Determination at the core of all service provision are: 1. Freedom: People choose supports and services, and enjoy the same civil rights that we all have. 2. Authority: People make decisions about their lives, direct their services, and control who is in their lives, where they live, and with whom they live. 3. Support: A circle of support is built around the person, which focuses on relationship development and natural and community resources to assist them to make decisions regarding their lives. 4. Responsibility: People learn how to manage life from both a personal and fiscal standpoint. Education, training, and mentoring are key in assisting the person to learn to use public dollars wisely and to become as independent and successful as possible. 5. Confirmation: People enjoy full citizenship within their community, have relationships, and have a clear understanding that no decisions are made without the person’s consent, involvement, and direction. People direct a fixed amount of funds that are derived from their Person-Centered Planning process and is called an individual budget. Soft Landing: ‘Soft landing’ is an OCCMHA financial philosophy and practice that is demonstrated by the use of Reserve Funds to help offset revenue reductions. It serves as a ‘bridge’ for budget reduction and transition planning. State Facility Revenue: In FY16, MDHHS assumed management of State Facility payments, so OCCMHA did not receive monthly revenue payments. Page 35
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Supports Coordinator / Case Manager: A person chosen by the individual served who, through PCP, assists them with the design and implementation of strategies for obtaining services and supports. System of Care: A coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families and youth work in partnership with public and private organizations to design mental health services and supports that are effective, that build on the strengths of individuals, and that address each person's cultural and linguistic needs. A system of care helps children, youth, and families improve at home, in school, in the community, and throughout life. Temporary Assistance to Needy Families (TANF): This Medicaid revenue is based on the number of people identified each month by the State to be in Oakland County that meet specific eligibility criteria of income, net worth, etc. They are primarily low-income families with children who are on family assistance programs with the MDHHS ‘Department of Human Services’ (DHS). OCCMHA is paid an amount each month that is computed through a rate, age / gender / geographic region, matrix calculated each year by the State actuary. The matrix is approved by the Centers for Medicare and Medicaid (CMS) as part of the Waiver approval. Trauma – Informed: Trauma-informed services acknowledge that lived experiences are the basis for therapeutic decision-making. They promote choice and empowerment for successful treatment. This approach is based on the recognition that many behaviors and responses (often seen as symptoms) expressed by people served are directly related to traumatic experiences that often cause mental health, substance use, and physical health concerns. Incorporating trauma-informed values and services is key to improving services and supporting the healing process. Use Tax: A 5.98% tax on Medicaid revenue. Value-Based Contracting: Value-based contracting involves payment or reimbursement based on indicators of value, such as health outcomes, efficiency, and quality. Value is generally understood to be defined as the result of quality divided by cost, or the health outcomes achieved per dollar spent.
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